Flight-simulator company tackles surgical scenarios
What does landing a jumbo jet on an icy runway have in common with performing gallbladder surgery? Both take practice before they can be done safely.
“In both cases the stakes are high and an error can be a catastrophe,” says Robert Amyot, president of CAE Healthcare, a division of CAE Inc.
Known for its flight simulators, CAE now makes simulators to train both surgeons and pilots — devices that not only recreate high-stakes situations to be as real as possible, but also collect the information needed to learn from mistakes before trainees take people’s lives into their hands.
Though the two fields may seem to be worlds apart, Amyot says there are more similarities between the cockpit and the operating room than meets the eye.
“You have to be prepared for something that’s unlikely to happen but when it happens you need a co-ordinated effort from the team,” he says. “Simulation centres are perfect environments to practice unlikely events.”
Standing over a stretcher, Patrick Longcore watches the blips on an electrocardiogram as he and his colleague Garret DeJong consult on the best treatment for Apollo, a patient being transported by plane.
Longcore is the international training co-ordinator for Global Rescue, a Lebanon, N.H.-based company that provides travel risk management services, including medical air evacuations from all around the world.
Apollo makes wheezing noises and has an irregular heartbeat.
“Flight implications: are we going to keep flying or divert?” Longcore asks.
“Notify ground transport to meet us at the tarmac. Longer term would be to consider additional supplemental oxygen because of the low state of perfusion,” replies DeJong, a Global Rescue Operations Specialist.
Though this scenario is being executed with utmost seriousness, it’s happening not in the air on a real patient, but in a demonstration room at CAE’s Montreal headquarters, where Global Rescue is considering purchasing an Apollo model to train its flight medic staff.
CAE says that 300 people — the equivalent of a Boeing 737 full of passengers — die every day in the U.S. due to medical errors.
Apollo looks like a person, complete with realistic rubber skin and eyes with pupils that react to light. He also has the physiology inside to mimic bleeding, breathing, swelling and secreting, along with the various sounds that can indicate the state of a patient’s health.
Longcore is a former training instructor for the U.S. army’s school for aviation medicine, and has been working with patient simulators for nearly a decade.
“We always used to say ‘train like you fight,’ so the closer to real we can get with that simulated training technology, the much better off we’ll be,” he said.
Longcore says long-distance air transport provides its own set of medical challenges beyond that of an ambulance ride. This means that with the possibility of personnel managing a crisis for several hours without assistance, they have to be prepared for intense emotional situations.
“Generally, people fall back to the level of their training,” he says.
CAE’s chief safety officer Lou Nemeth says the repetition of simulation exercises allows trainees to reach a higher level of understanding he calls “clairvoyance.”
“When you see enough of these situations through simulations over and over again, as it begins to unfold you become clairvoyant. You’ve seen this before, know where this is going, and you’re able to take mitigation prior to the psycho-physiological shock,” he says.
The benefits of simulators have been measured and are defined, according to Dr. Rajesh Aggarwal, director of McGill University’s Steinberg Centre for Medical Simulation and Interactive Learning.
Aggarwal first studied the use of virtual reality for laparoscopic surgery training in 2003.
Laparoscopic procedures involve intricate manoeuvres with small instruments inside a patient’s body, guided only by a two-dimensional image on a screen, so it can take a surgeon dozens of operations before mastering the technique, Aggarwal says. This accepted “learning curve,” he adds, might better be described as a “harm curve.”
“We as health-care practitioners have accepted that it is OK to get better in the clinical domain,” he says.
“Part of this I really think is for us to look in the mirror and be transparent ourselves to say ‘we are doing harm.’”
Aggarwal says he used to believe available infrastructure and technology was holding back the adoption of simulators, but now he believes the problem is with the health-care system, which has not made these devices a mandatory part of training.
“I don’t want to scaremonger people to think all this awful stuff is happening,” Aggarwal said. “Medicine is great and we’re doing a great job of delivering care. We just need to be thinking about how we do that better.”